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General NPI Number Information
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NPI Number | 1235765397
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Entity Type | Individual
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Provider Name | CAITLIN NORA KELLY LCAT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 1339 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10021-4707
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Country | US
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Telephone | 212-628-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 128 CATSKILL AVE
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City | YONKERS
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State | NY
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Zip | 10704-1919
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Country | US
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Telephone | 914-262-4517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 002447-01
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License Number State | NY
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